Artificial Intelligence (AI) seems to be all the rage now. As for applying it to the VA claims process, I expect a lot of Veterans are going to spend mucho dinero chasing an AI unicorn and be poorer for the effort soon. Granted, the VA claims process is daunting enough- and even more so since they reinvented it and “simplified” it with the AMA. But complicating it with the AMA and then salting it with a cacophony of AI is going to result in a ever-larger tsunami of denials. The reason is simple. I’ve been observing this process since 1989. Every time  a new trick is discovered to “get there”, VA revamps the system to plug the hole in the dike. Read on.

After umpteen denials and untold ‘not well-grounded’ Dear Alex letters from Uncle Ed Derwinski and his progeny in my early years, I eventually ran into the CAVC (formerly COVA) website and the BVA decisions site in 2008. In 2006, there was no talk of nexus letters or IMOs. Most of us just kept plugging away with defective buddy letters, contemporary photos and futile pleas for the benefit of the doubt. Veterans actually had a statistically higher chance of winning the Publisher’s Clearing House Sweepstakes or the Powerball Lotto.

Being sick as a dog and unable to work, I began an Occam’s Razor examination of why Vet A prevailed and Vet B lost. I began by reading every CAVC (COVA) decision from 1989 to about 2006. That really didn’t help as I had no legal acumen. However, the BVA decisions website was more explicit. Here, you got to examine a case with the end result (win or lose) at the beginning followed by a precedential rationale legally speaking. It was easy to sort through and segregate all the wins together and relegate the losses to the circular file. But, in the process, I at least began to see the legal rationale for the wins.

No secret handshake had to be learned. No 8-character password with a number and a character had to be memorized. All you needed was that magic paper from a Doctor saying the nexus words for you. It was so simple, I doubt most would have discerned it. As soon as I published that Rosetta Stone, they changed the game. No longer would a simple explanatory letter do. The next  iteration was that VA’s examiner had read the entire claims file (or claimed to have done so) and your doctor didn’t so they had the complete picture.

That was an easy fix but incurred a six-month delay for the most part just to get the claims file. Most Veterans’ doctors were just that-Doctors. They had patients whom they serviced and they didn’t have time (or Adobe Acrobat OCR) to ingest a 1,300 page file with everything from your anal temperature at entry to your inoculation records. This gave birth to a nascent industry of Independent Medical Opinions. Granted, the field had existed for aeons but was very expensive. Most non-VA attorneys used this process for malpractice claims. It wasn’t unheard of to hire a specialist to come across the country to testify at your trial for about $30 K plus dealer prep and destination fees and a fuel surcharge on top.

The next change was VA examiners (read raters) picking apart your IMO and finding some miniscule fault to deny on. Arguments began to surface as to whether your lay testimony was credible or whether you were competent to discourse on whether you had a transfusion after you got that through and through GSW. If it wasn’t in the records, it never happened. The hole in your chest and exit wound didn’t mean anything. Purple Heart? So what?

The IMO game has evolved from there. Just getting one is no longer the panacea it used to be. The reason is simple. More and more Vets are turning to the Claims Shark model of VA litigation and hiring former VA examiners as Sherpas to lead them up the claims mountain. The Sherpas, in turn, have a comprehensive development team to provide you with the IMOs, coach you on how to write the perfect lay testimony in support of your claims, and, in some cases, file the whole shiteree for you. Newsflash. VA reads the newspaper too.

As most know by now, this Sherpa model is a) illegal as hell; b) has more hooks on it than a Heddon™ Tiny Torpedo; and c) will cost you waaaay more than if you’d just hired an Agent or attorney. Granted, there are good arguments on both sides for using attorneys/agents/VSOs versus the new Shark model. The attorneys, for the most part, know the legal side, are becoming more acquainted with the IMO theorem and have a high win to loss ratio. The Sharks don’t have to obey the rules so they can cut corners. They keep their own doctors or psychologists on tap along with a bevy of Nurse practitioners to write the IMOs for “free”. When you win, they descend like vultures to collect the lion’s share. “Free’ gets a new five-figure definition-but only if you win. I’ve recently seen an IMO denied because the doctor’s address was the same as the claim shark’s office address. Can you say ‘independent’?

This art form has been around for scores of years. It used to be they just charged for the IMO itself. Representation was an additional 20%. I’m sure most of you are no strangers to a few in the industry who perform ‘holistic’ medical opinions. These IMOs look at the whole you from stem to stern. Who cares if you didn’t have flat feet in the Army? Turns out that bunion you went to sick call for in ’68 was just the beginning of it. Your knees gave out because of the feet. The knees are connected to the L5-S1 bone so that’s part of it too. And in 1992, you might have gotten away with it. But not now, kemosabe.

These days, you can hire a real neurologist to opine on why you’re dizzy 24/7, have excruciating headaches and go through wives like toilet paper.  They can cite to 21 peer-reviewed articles published in JAMA explaining your TBI via an RPG in the king’s English. VA can send you out for a 20-minute c&p by Shaniqua Brown, NP-FNP (TBI-certified by Optum Serve) who attributes it to the post-service MVA where you got a fender bender. As I said, this game has changed over the years. For me, it now almost always entails a trip to the BVA on appeal to get justice.

Enter AI. Several days ago, one of my compadres ran into a new wrinkle. The VA Claims Academy® has a new technique using AI that can write out the whole claim- including the lay testimony for you. All you need to do is arrive on their doorstep with you VISA© card in hand. I didn’t get into the fine print but I’m guessing they also have the complete complement of doctors and nurses just itchin’ to nexus everything on or in you to, well, something in service. Maybe you were stationed in England in the Air Force when those aliens landed back in ’80. Who said your claim for PTSD due to alien abduction is far-fetched? AI can fix that.

The art of the nexus letter has advanced far more than just asking your treating physician to write one for you. Be prepared for a a large dose of VA skepticism. In fact, I’m seeing them question whether my Vets are engaged in fraud. I’ve had a VA doctor say (in his own IMO) that private IMOs are bogus because the Vet’s clinician has a vested interest in it. It has to be bogus- they were paid to produce it. Case closed, right? Think that one through to its logical conclusion. Does the VA subcontracted VES author of an ‘independent’ VA medical opinion denying your entitlement to __________ work for free? Of course not so that’s like the pot calling the DEI kettle black.

With AI, you can fabricate everything but the National Provider’s Identification number (NPI). The DEA assigns the number when you become a licensed medical provider. I had one rejected last month for that reason. Just for shits and grins, I googled the doctor and bingo-there’s his NPI in his bio. You’d think a VA rater with a room temperature IQ could find that. You’d think wrong. I reckon VA doesn’t have access to Google.

I see a bad moon rising for Veterans with the advent of AI. I’d feel a lot more comfortable if the ocean full of claims sharks wasn’t there because all it does is taint us legitimate accredited representatives who play by the rules. What’s worse, the sharks have hired  oodles of lobbyists to let them practice with no oversight because well, gee, there aren’t enough accredited reps to go around. How about if all the sharks just sit for the VA OGC exam if they are so knowledgeable and capable? Why the approbation and feeling they are being discriminated against? Shoot. Just look at those impressive big dollar wins they’re bringing in. Having a sheepskin to hang on the wall saying you’re legit would seem to be good for business. Besides, it costs $0 dollars to get your accreditation.

In closing, I think the answer to this quandary of legitimacy must always be governed by logic. Attorneys, doctors, nurses, paralegals, and yes, especially us lowly Agents require some supervision to give this process the semblance of respectability. But how about some certificate of competency for VA’s DROs, RVSRs, Coaches and VSCMs attesting to their bona fides? Why do they get a bye on the licensure requirements?   It’s patently obvious from VA’s adjudicatory record that VA screws up 74% of everything they touch. In fact, in this business, getting it right is increasingly more an anomaly than a given.

I’ve always been one to play the Devil’s advocate of my own claims- if for no other reason  than to ferret out a fatal flaw to my legal logic. The argument for less, or no accreditation strictures whatsoever, doesn’t pass the logic test nor the claims sharks Rodney King plaint of ‘can’t we all just get along?’  that they should be presumed to pass muster in the legal proficiency arena. Accreditation? We don’t need no stinkin’ accreditation! That’s a specious argument like saying the government shouldn’t require you to have a driver’s license to drive a car. Or better yet, lawyers shouldn’t have to go to law school and pass the Bar to practice. Right?